“To live as a gay man in the world, even here in the west, means skirting round violence every day.” So says Russell T Davies, the creator of the increasingly harrowing LGBT drama Cucumber. Last night’s episode was surely one of the most unsettling pieces of drama to grace our TV screens in recent times: judging by the distressed reaction on Twitter, it left many viewers with restless nights. The episode opens by informing us that one of the main characters, Lance, is going to die. Recently abandoned by his long-term partner Henry, who abortively seeks liberation in singledom, Lance seeks solace by pursuing Daniel, a deeply conflicted, ostensibly heterosexual man. After a powerful fast-forward through Lance’s life – first girlfriend, coming out, family rejection, Aids, love – it culminates with a final fateful scene of a creepy sexual encounter and his chilling murder.

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Davies is right: he knows that, deep down in the psyche of many LGBT people, there is a sense of foreboding. Most of the world would prefer that LGBT people did not exist. Gay men are thrown from tower blocks and stoned to death by Isis thugs in Syria; they face death by decapitation in Saudi Arabia; in Latin America, they have been facing a wave of brutal murders. The struggle of LGBT people in Britain has led to legal discrimination by the state being stripped away, and has transformed attitudes, though about a fifth of the population admit to thinking homosexuality is “always wrong”. Boys are encouraged to conform to a rigid, aggressive form of masculinity from an early age, policed by homophobic abuse (“stop being such a poof”).

Reminders – some subtle, others less so – that you’re not quite equal are pervasive: the look of horror on a straight man’s face when he’s “accused” of being gay, as though it’s a cross between being a leper and a thief; the use of gender-neutral “partner” because it’s been a long day and you can’t be bothered coming out again for the 987th time; someone’s OTT attempts to prove that they’re OK with people being gay, a form of being patronised that reminds an LGBT person of their inferior status nearly as much as straightforward abuse. For some, the background noise of homophobia can feel like living under an authoritarian regime underpinned by a network of informants, forcing them to remain undercover. You don’t dream of holding hands with a partner: a graph of “likelihood of being verbally or physically assaulted” appears in your head, and the line surges upwards if you do.

That grim episode of Cucumber is a reminder of how destructive a prison sexuality can be. Various studies have suggested that the prejudice of some homophobes may be linked to their own repressed same-sex desires. Russell T Davies also refers to “gay panic”: a form of defence in incidents of assault and murder in which a straight individual argues a gay advance provoked them into violence. This defence still exists in much of the western world.

A piece like this needs a caveat. Because LGBT people struggled back, life is so much better than it was for previous generations. But that episode of the superbly written and acted Cucumber particularly unsettled many of its gay viewers for good reason. It tapped into a profound, embedded sense of their own vulnerability and precariousness, even now, in Britain, in 2015. That final scene will linger in my own head for quite some time.

• The headline of this article was changed after launch to remove a plot spoiler